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EW MEETING REPORTER 92 February 2011 On Tuesday, January 18, Hawaiian Eye 2011 focused on cataract and refractive surgery. Mini-symposium on vitroretinal issues for cataract surgeons Elias Reichel, M.D., Boston, talked about assessing the macula in cataract surgery patients, which is "critical for patient expectations." Dr. Reichel said photo documenta- tion is important, and he uses OCT pre-op. "Patients really understand OCT," he said. "When they see the picture, they understand macular pathology." Even if patients have ex- cellent vision, they can still have macular holes or diabetic macular edema, Dr. Reichel stressed. He con- cluded that OCT will identify abnor- malities and treatable macular disease before cataract extraction and should be used even if patients are seeing well. "I personally believe that all patients who are having a surgical procedure, particularly in the elderly population, should have a pre-operative OCT to document abnormalities. As far as excellent pa- tient care, which is what our goal is, we should document a pathology if it exists or if it doesn't." Mark Blu- menkranz, M.D., Menlo Park, Calif., discussed reducing the risk of retinal detachments. "I thought I'd share some late-breaking news with you in an area that's really controversial and interesting in retina circles, and that is how to treat pseudophakic retinal detachments," he said, adding that vitrectomies, with or without scleral buckling, increased by 72% in the last 10 years. Scleral buckling procedures alone decreased by 69%. "Clearly vitrectomy is in- creasingly coming into favor, and scleral buckling alone is decreasing in favor in the treatment of retinal detachment," he said, adding that there still isn't a consensus on which one, including pneumatic retinopexy, is best. "All of these pro- cedures work, and, in the hands of an excellent surgeon, they're proba- bly all good equally in many ways over the long term. The choice of surgeon may be a more relevant metric for patients, and individual case selection is still most critical." Daniel F. Martin, M.D., Cleveland, said surgeons should try and recog- nize complications during anterior vitrectomy as early as possible. "Look for capsular tears, deepening of the anterior chamber, pupillary dilation, decreased followability, or inability to spin the nucleus," Dr. Blumenkranz said, adding that sur- geons need to remove the cortex safely and efficiently, suture the wound closed, and elevate nuclear fragments with dispersive viscoelas- tic. "The key is do not phacoemul- sify the vitreous," he said. Dr. Blumenkranz said if the structure of the capsule is good, go ahead with placing an IOL. "Please only place one," he said. "I've had this happen where the surgeon sees that the cap- sule is still intact and places a sulcus fixated IOL," and another in the an- terior chamber. "I've had to take out the AC IOL that was put in, bring out the dislocated AC IOL, and put the AC IOL back." He said that if a lens is lost pos- teriorly during surgery, it's ideal to find a retina surgeon while the pa- tient is on the table, but it's not es- sential. "It's not an emergency, but don't sit on these cases," he said. "Do not chase the lens." Panel discussion: Femtosecond laser cataract surgery—the new frontier In a session led by David F. Chang, M.D., Los Altos, Calif., and Roger F. Steinert, M.D., Irvine, Calif., a panel discussed femtosecond-assisted cataract surgery. Three companies on the fore- front of the procedure were repre- sented by their respective advisory board members. Michael Knorz, M.D., Mannheim, Germany, dis- cussed using the femto laser for an- terior capsulotomy and said that capsulotomies with the laser showed reduced variability and were safe and effective in liquefaction, capsu- lorhexis, and corneal incisions. "Laser capsulorhexis was perfectly centered and highly reproducible in all cases," he said. Barry S. Seibel, M.D., Los Angeles, said femtosecond technology with OCT visualization allows surgeons to explore architec- ture they couldn't see before, includ- ing side view, "which we simply can't see through a surgical micro- scope," he said. The optics of the femtosecond laser for cataract tech- nology have improved, he said. "We needed to have a larger area so that we can see the surgical limbus with regard to limbal relaxing incisions and re-incision placement." Louis D. "Skip" Nichamin, M.D., Brookville, Pa., asserted that fem- tosecond laser lens fragmentation re- duces the amount of ultrasound energy required to remove the nu- cleus. "We're able to not only reduce and eliminate phaco energy … we're currently showing we're able to ex- pand into the more dense nuclei." Editors' note: Dr. Blumenkrantz has no financial interests relevant to his talk. Dr. Lindstrom has a financial interest with RevitalVision (Lawrence, Kan.). Dr. Knorz has a financial interest with LenSx (Alcon, Fort Worth, Texas). Dr. Seibel has a financial interest with Op- tiMedica (Santa Clara, Calif.). Dr. Nichamin has a financial interest with LensAR (Winter Park, Fla.). Speakers at the Hawaiian Eye meeting on Wednesday, January 19, focused on glaucoma research, diagnosis, and treatment. Genetics in the glaucoma clinic Researchers are close to using genet- ics to identify and treat glaucoma patients, said Janey Wiggs, M.D., Ph.D., assistant professor of oph- thalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston. Dr. Wiggs and her associates at Harvard are undertak- ing a major effort to find genes asso- ciated with primary open-angle glaucoma. The NEIGHBOR study, or NEI Glaucoma Human Genetics Col- laboration, is a collaboration be- Reporting live from the 2011 Hawaiian Eye Meeting, Maui, Hawaii by Jena Passut Editors' note: This Meeting Reporter contains original reporting by the EyeWorld news team continued from P. 91

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